Most Relevant Information
Provider Data
| NPI Number: | 1003399403 |
| Provider Name: | MARK GONCHAR LASAC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | 13156 |
Most Important Dates
| Enumeration Date: | 09/11/2018 |
| Last Updated: | 09/11/2018 |
Provider Practice Location
3095 E CORONADO TRL
RIMROCK
AZ
863355284
Practice Location Phone/Fax
| Phone: | 9285671322 |
| Fax: |
Provider Mailing Location
PO BOX 230
RIMROCK
AZ
863350230
Provider Mailing Phone/Fax
| Phone: | 9285671322 |
| Fax: |